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First Author: L.Salerno BRAZIL
Co Author(s): A. Souza N. Salerno
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To report two cases of severe fungal keratitis caused by Fusarium, both treated with voriconazole in different administrations: intrastromal and intracameral injections.
Cornea and external diseases services at a terciary care hospital in Brazil.
Two patients with aggressive deep stromal keratitis caused by Fusarium not responding to conventional antifungal medications received complementary treatment with injectable voriconazole. In the first case, RB, a 49 years old female who has renal disease associated with hepatitis C presented with corneal ulcer with dense and deep infiltrate. In the second case, DZ, a male of 41 years old, soft contact lens user, previously healthy, presented with corneal ulcer and deep infiltrate. Instead the initial use of 5% topical natamycin hourly and 200 mg of oral ketoconazole twice per day the melting progressed in both cases with impending perforation risk. Voriconazole (50 microg/0.1ml) was injected in the corneal stroma around the lesion twenty days after the initial treatment in the first case. Voriconazole (100 microg) was injected in the anterior camera twenty-two days after the initial treatment in the second case. Topical 1% voriconazole hourly was also started after the injections.
In both cases adjunct treatment with injectable voriconazole dramatically contributed for a completely resolution of the infection. The full recovery was seen fifteen days after the intrastromal injection of voriconazole in the first case (Fig. 3) and twenty days after the intracameral injection of voriconazole in the second case (Fig. 4). Only one injection was needed and no side effects were noted.
The use of intrastromal and intracameral voriconazole may be an effective adjunct treatment for aggressive fungal keratitis caused by Fusarium.